PB2342: A REVIEW OF BONE MARROW BIOPSIES PERFORMED AT A LONDON TEACHING HOSPITAL: DO BONE MARROWS AID DIAGNOSIS AND AT WHAT COST?
Authors: M. Mahbub, N. Chauhan
Journal: HemaSphere (2022)

Background: Bone marrow aspirate and trephine biopsy (bone marrow biopsy) are an establised test to diagnose haematological disease. In addition to diagnostics, the bone marrow biopsy also aids staging, management and monitoring. However bone marrow biopsies are invasive, require specialist practitioners and can cause pain and other complications to the patient. Analysis has to be performed in a timely manner by specialists alongwith highly complex tests with their own costs. Bone marrow biopsy is therefore an expensive test with a 2020/21 hospital tariff of £964 (1155 EUR, 1285 USD). This is likely to be less than the true charge given the expense of specialist testing, transport to off-site laboratories, analysis and storage of samples in line with UK regulations. At our institution bone marrows are performed only if consultant-approved by a qualified practitioner. Aims: To review all bone marrows performed at a London teaching hospital across 6 months for their indications, eventual diagnosis and aid to patient care. Methods: A retrospective audit was performed for all bone marrow biopsies performed by our department over a 6-month period (1st August 2021 and 31st January 2022). Biopsy samples were identified by request and report. Biopsies were checked against the agreed indications from the International Standards for Standardization in Hematology (ICSH) and their concluding diagnosis and aid to patient care assessed Results: 81 bone marrow biopsies were identified and assessed.Patient demographics showed age ranged from 24 to 91 years (median 65 years) with similar male to female ratio (Male 1.3:1 Female). The majority of biopsy requests came were for outpatients (73%) rather than inpatients (27%). The consultant making the most requests were from our Haematology faculty (84%) with the remaining being largely requested by the Hepatology (5%) and Nephrology (4%) teams and performed with agreement by a Haematologist. All biopsies met the indications agreed by ICSH. The most common indication for biopsy was diagnosis, staging and follow up of malignant haematological disorders (74%) with myeloproliderative neoplasms and plasma cell dyscrasia predominating. 66% of bone marrow biopsies reached a diagnosis, 34% of biopsies were non-diagnostic or non-contributory. Summary/Conclusion: Despite advances in radiology and peripheral blood analytics, a bone marrow aspirate and trephine examination has a significant role in diagnosis, staging and management of haematological disorders. Our audit suggests that 160 bone marrows would be performed across a 12-month period and would cost commissioners £160,000 (191,000 EUR, 213,000 USD) although diagnostic lab costs have been higher than this in previous years. This audit confirmed that a consultant-led approach means bone marrows meet approved indications every time. Although for the majority of patients a diagnosis is made a third do not reach a diagnosis. A normal bone marrow can be useful where, for example, the patient has undergone a biopsy for an incidental peripheral blood finding. However within this group there will be patients who have undergone an invasive test, with known complications and cost, for no positive change to their care and it these patients where the role of bone marrow biopsy has to be questioned.